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- Ekholm, Sara
(author)
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Föräldraskap och klimatoro – betydelsen av omsorg
- 2023
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Doctoral thesis (other academic/artistic)abstract
- The aim of the thesis is to study the relationships between parenthood, care and worry about the consequences of climate change and how these relate to climate behaviour. The thesis is based on the argument that care affect the degree of worry for the person to whom the care is directed and that the social context surrounding the individual has an influence on their experiences and worries about risks, in this case climate risks. In relation to climate change worry, it addresses differences in care practice between parents and people who are not parents, and between mothers and fathers. Time and practice with caring responsibilities may differ between these groups and may therefore also relate to levels of worry. Care practice can thus be one of several aspects that can be significant for climate change worry. Four studies have jointly addressed the overall purpose of the thesis and a ‘mixed methods’ approach has been used where quantitative and qualitative methods have been combined. The studies have thus complemented each other through four different sets of empirical material: three sets of quantitative survey data with random samples and one set of qualitative interview data. The empirical context of the survey studies includes a regional and a national survey in Sweden and a European survey. The qualitative material is based on interviews with respondents from several regions in Sweden that are vulnerable to climate change. The results of the thesis as a whole show a recurring pattern, in a Swedish context, regarding the relationship between parenthood and worry about the consequences of climate change. They show that parents in general are more worried about climate change than people who are not parents (Articles 1, 2 and 3). So, this pattern is reflected in the three independent surveys mentioned above, conducted at different times over a six-year period. The results also show that women are generally more worried than men are about the consequences of climate change. Fathers, on the other hand, are significantly more likely to experience climate change worry than men who are not fathers, a difference that is not evident between mothers and women who are not mothers (Articles 2 and 3). One of the studies (Article 3) examine whether the role of parenthood, as well as the role of mothers and fathers, differs between three care regimes (Orloff, 2002), in relation to climate change worry. Regimes here refer to normative and regulatory systems that are not reduced to individual institutions in society (Hood, Rothstein & Baldwin, 2001). It is only in the care regime prevailing in Sweden that parenthood reveals a significantly greater degree of climate change worry, both between parents and people who are not parents and between fathers and men who are not fathers. One possible explanation for this may be the nature of care regimes and how they relate to the individual, including the regulation of care time structures for both men and women through parental insurance. The fact that climate change worry increases for men who become fathers may be about the development of “caring masculinities” (Elliot, 2016) that relate to men’s emotional experiences such as worry, here through their spending time with their children. This seems to be particularly evident for men who become fathers in contexts where men are given more time for care practice, as shown in the Swedish context. Parents’ worry about the impact of climate change thus appears to be linked to care practice. A term for this kind of worry is referred to in the thesis as care-worry (Article 4) and includes a worry rooted in caring for and having a responsible attitude towards other people, both towards the specific child being cared for, and a concern for people in general and for future generations. This is supported by van Manen’s (2002) argument that worry is part of caring. People’s care-worry is also shaped by the specific context of discourses about caring, worry and risk (see Lupton, 2013; see also Giritli Nygren, Olofsson & Öhman, 2020). Based on parents’ experiences of climate change, the concept of care-worry has been empirically explored (Article 4) and reveals four ideal types that can illustrate parental care-worry in different ways. These are the worrying type, the trusting type, the calculating type and the security-seeking type. Differences between the ideal types are evident in the degree of worry, sense of uncertainty about the future and desire for control or security, with the common link of taking responsibility for the climate situation. Parents’ different types of climate behaviour can also be related to their type of care-worry. The worrying type talks about the climate situation with others, while the trusting type cares about sustainable consumption and is confident that global climate action will solve the climate situation. The calculating type focuses primarily on a climate-mitigating approach, such as reduced energy consumption, and the security-seeking type on a lifestyle adapted to the climate by means of such things as sustainable housing. Parents’ care-worry thus seems to relate to practical action with climate behaviour that takes personal responsibility for limiting the impact of climate change on future generations. The overall conclusions and contributions of the thesis are thus essentially that parenthood is significant for worry about climate change in the Swedish care regime, i.e. that parents have greater climate change worry than those who are not parents. It is also the case that in Sweden fathers’ climate change worry is greater than that of men who are not fathers, a difference that does not appear in women who become mothers. Caring for children can thus increase worry about the consequences of climate change, i.e. parents experience care-worry in relation to future climate risks that their children and other people may face. A further conclusion is that care-worry can also be a motivating aspect to act on climate change by limiting one’s climate impact for the sake of future generations.
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| 2. |
- Karlsson, Åsa, 1972-
(author)
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Team-based home rehabilitation after hip fracture in older adults : effects, experiences and impact of dementia
- 2021
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Doctoral thesis (other academic/artistic)abstract
- BACKGROUND: For an older adult a hip fracture may be a traumatic and life-changing event and has shown to be associated with reduced health-related quality of life, disability and increased mortality. Previous rehabilitation studies have often excluded older adults with cognitive impairment and those living in residential care facilities, groups with an additional risk of poor outcome. Moreover, there are few randomized controlled trials that have evaluated interdisciplinary home rehabilitation after hip fracture. These studies did not include older adults with severe cognitive impairment or dementia, those with serious medical conditions, or those living in residential care.OBJECTIVE: The aim of the thesis was to investigate the effects of early discharge followed by geriatric interdisciplinary home rehabilitation (GIHR) for older adults with hip fracture, and specifically among those with dementia, compared to in-hospital geriatric care according to a multifactorial rehabilitation program. An additional aim was to explore how older adults experienced their rehabilitation and recovery during the year following the fracture.METHODS: The thesis evaluated a randomized controlled trial that included 205 participants with hip fracture, 70 years or older, living in ordinary housing or residential care facilities. In hospital, both the GIHR and control groups received care and rehabilitation according to a multifactorial rehabilitation program, but with the aim of early discharge for the GIHR group. The individually designed GIHR intervention focused on walking ability indoors and outdoors, independence in activities of daily living (ADL), and multifactorial fall prevention during a maximum period of 10 weeks. Participants were assessed in-hospital and at 3- and 12-month follow-up visits. Independence in walking and use of walking aids was assessed via an interview along with gait speed tests. Independence in ADL was measured using the Barthel ADL Index, and the ADL Staircase including the Katz ADL Index, and hospital length of stay (LOS) was recorded from medical charts. The effects of GIHR intervention among participants with dementia were investigated in a post hoc subgroup analysis where additional outcomes were falls, mortality and readmissions between discharge and 12 months. Individual interviews were conducted with 20 selected participants just after the 12-month follow-up. Data were analysed using qualitative content analysis.RESULTS: The postoperative hospital LOS was significantly reduced by a median of six days in the GIHR group compared to the control group, although not significantly reduced in the GIHR group for participants with dementia. Binary logistic regression analyses revealed no significant differences between the GIHR and control groups regarding independent walking ability, the ability to walk without a walking device, or independence in ADL at 3 and 12 months. Gait speed was comparable between the two groups at 3 and 12 months. At 12 months, 56% in the GIHR group and 58% in the control group had recovered their prefracture walking ability, and 41% vs. 42% in GIHR and control groups, respectively, had regained their prefracture Barthel ADL Index score. Interaction analyses showed that the GIHR group vs. the control group had comparable effects on walking ability and ADL at 3 and 12 months, and on falls and mortality between discharge and 12 months, regardless of whether the participants had dementia or not (P≥0.05 for all). The number of readmissions and hospital days after discharge was comparable between GIHR and control groups for participants with dementia. Overall, dementia was associated with significantly impaired walking ability and greater dependence in ADL at 3 and 12 months and with increased risk of falling and increased mortality between discharge and 12 months compared to participants without dementia. The interviews revealed that access to rehabilitation, provided by skilled staff, and support from others were important for participants’ well-being and recovery. Participants experienced a fundamental change in their self-image after the fracture, and faced a number of difficulties, but strove for independence and used adaptive strategies to find contentment in their lives.CONCLUSIONS: In older adults with hip fracture, early discharge followed by interdisciplinary home rehabilitation significantly reduced postoperative hospital LOS. Functional recovery during the year following the fracture was nevertheless comparable to in-hospital geriatric care according to a multifactorial rehabilitation program. The GIHR intervention seems to be appropriate also for older adults with dementia since the effects were not different in this subgroup, except for postoperative hospital LOS, which was not significantly reduced in the GIHR group for participants with dementia. Further studies with larger samples are needed to validate these results. Overall, dementia was associated with a substantial negative impact on the outcomes. According to participants’ experiences, receiving rehabilitation and support after the hip fracture seems crucial for successful recovery. Negative psychological reactions were common, suggesting that future interventions should consider both physical and psychological aspects. Different rehabilitation alternatives were appreciated by the participants. Rehabilitation should thus be customised to suit wishes and needs of older adults and may accordingly be carried out in different settings, where rehabilitation in the home can be one suitable alternative. The findings of this thesis indicate that geriatric interdisciplinary home rehabilitation after hip fracture can be an alternative and a complement to in-hospital care and rehabilitation for older adults with and without dementia.
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| 3. |
- Lyu, Yezhe, 1987-, et al.
(author)
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Recycling of worn out brake pads impact on tribology and environment
- 2020
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In: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 10:1
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Journal article (peer-reviewed)abstract
- Disc brake systems are widely used on commercial vehicles for braking. The brake pads are usually replaced by new ones before being totally worn out. Current methods to deal with the replaced brake pads include landfill and combustion, resulting in a huge waste of resources and increase of CO2 footprint. From a sustainable point of view, this study aims to evaluate the feasibility of recycling replaced brake pads by addressing a protocol recycling procedure. The results show that the recycled brake pads yield similar friction, wear and airborne particle emission to virgin brake pads. A streamlined life cycle assessment is conducted to compare the environmental impacts between producing virgin brake pads and recycling replaced brake pads. Energy consumption and CO2 footprint of the recycled brake pads are 36% and 34% less than virgin brake pads, indicating that recycling could be a promising method of handling replaced brake pads.
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| 4. |
- Ma, Jijie, et al.
(author)
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A Comparison of Airborne Particles Generated from Disk Brake Contacts : Induction Versus Frictional Heating
- 2020
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In: Tribology letters. - : SPRINGER/PLENUM PUBLISHERS. - 1023-8883 .- 1573-2711. ; 68:1
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Journal article (peer-reviewed)abstract
- Volatile emissions of vehicle brakes relate to the high temperature of the brake friction pair. However, as a passive parameter of braking applications, temperature is usually studied together with other parameters such as sliding speed and load. Heating tests that increase the friction pair temperature with an induction heater instead of friction are proposed in this study to imitate the rise in temperature in friction tests. Non-friction airborne particles produced solely by the high temperature in heating tests were studied in comparison with friction tests. The results confirmed the existence of non-friction airborne particles and they can represent about 4.5% of the total airborne particles in friction tests. The high-temperature behaviour as well as the composition of the non-friction airborne particles is also presented.
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| 5. |
- Olofsson, Ulf, 1962-, et al.
(author)
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Laser Cladding Treatment for Refurbishing Disc Brake Rotors : Environmental and Tribological Analysis
- 2021
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In: Tribology letters. - New York : Springer Nature. - 1023-8883 .- 1573-2711. ; 69:2
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Journal article (peer-reviewed)abstract
- In this study, grey cast iron disc brake rotors are refurbished by adding a surface layer through laser cladding. Current methods to deal with replaced rotors mainly include remelting, with a minority fraction disposed in landfill. Both approaches result in a huge waste of resources and an increase in CO2 footprint. From a sustainable point of view, this study aims to evaluate the feasibility of refurbishing brake rotors by a combined environmental and tribological performance approach. A streamlined life cycle assessment is conducted to compare the environmental impacts between producing virgin grey cast iron brake rotors and refurbishing replaced brake rotors by laser cladding. It turns out that the energy consumption and CO2 footprint of the laser cladding refurbished brake rotors are 80% and 90% less than the virgin brake rotors. The results show that the refurbished brake rotor yields higher friction compared to the original cast iron utilizing the same pad material. The wear and particle emissions of the disc brake contact are in this study higher for the laser-cladded one compared to the original cast iron one.
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| 6. |
- Unneby, Anna, 1985-
(author)
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Pain and pain management with femoral nerve block following hip fracture : effects and experiences: the perspective of older patients and staff
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Background: Older people with hip fractures are often frail with several comorbidities and roughly half of them have dementia disorders. Pain is common among patients with hip fracture and pain management in these patients is a challenge. Opioids are known to relieve pain while at rest but are not as effective in movement. One alternative to opioids is a femoral nerve block (FNB). Previous studies have shown that FNBs can decrease pain and the need for opioids, but these studies excluded patients with dementia. Few studies have investigated whether FNBs decrease the incidence of complications in general, and delirium in particular. These studies were also based on different types of nerve blocks and methods. Few studies have described patients’ experiences of pain and pain management, and there are no studies on patients’ experiences of receiving or being treated with FNBs. In addition, there are no studies on staff´s experience of nursing care among patients with hip fractures who received an FNB. Objectives: The overall aim of this thesis is to investigate the effect of a preoperative FNB in patients with hip fracture in terms of pain and complications, and, further, to describe experiences of pain and pain management among patients with hip fracture who received FNBs as well as staff´s experiences of treating them. The first two papers (I and II) investigate the effect of an FNB compared to opioids, with a focus on pain and complications. To gain a deeper understanding, the final two papers (III and IV) describe experiences of pain and pain management in patients with hip fractures who received an FNB, and the staff's experiences of nursing care with patients with hip fractures who received an FNB. Methods: Papers I and II are based on a randomized controlled study which included patients aged 70 years or older with hip fractures, including those with cognitive impairment or dementia. Patients were randomized on arrival at the orthopaedic ward in terms of pain treatment to be administered; the options were FNB (with opioids if needed) or opioids alone. In paper I, 266 patients were included; the mean age was 84 years, 64% were women, and 45% had a dementia diagnosis. Paper II included 236 patients; the mean age was the same, 66% were women, and 46% had a dementia diagnosis. Pain assessment scales (self-rated VAS and VAS by proxy) was used preoperative to assess patients’ pain in rest. Nurses assessed the incidence of delirium using Nu-DESC, both pre- and postoperatively. In addition, a structural interview was performed with validated assessments 3 to 5 days after surgery by the author (AU). The assessments, nursing and medical records were subsequently evaluated by a specialist in geriatric medicine together with a trained research nurse in terms of complications, dementia, depression and delirium. Data collected in papers I and II were analysed using comparative and descriptive statistical analysis. In papers III and IV, semi-structured interviews were performed with patients (paper III) and with staff (nurses and assistant nurses, paper IV) based on interview guides with open-ended questions that offered opportunities for clarification and follow-up questions. In paper III, 23 patients with hip fractures aged 70 years or older who were treated with FNBs were interviewed, and in paper IV, staff working in the orthopaedic ward and emergency department with experience of caring for patients with hip fractures treated with FNBs were interviewed. The interviews were audio-recorded, transcribed and analysed using qualitative content analysis. Results: The results in paper I showed that patients who received an FNB assessed lower pain scores over a period of 12 hours. Patients required smaller amounts of opioids and the number of patients requiring opioids was reduced compared with the group that received opioids alone. Overall, in paper II was it a high incidence of complications, common complications in both groups were pre and postoperative delirium (44% and 73%), nutritional problems (71%), anaemia (66%), constipation (64%) and urinary tract infection (45%), but no statistical difference was found between groups of those complications. The results in paper II showed that 39% of the patients who received an FNB and 49% of those who received opioids developed delirium before surgery, with no statistical difference. In paper III, patients described how the pain before surgery was experienced from no pain, to the worst possible pain and everything in between. They described how they dealt with pain in their own way, but also how they felt dependent on the staff's willingness to relieve the pain. They described that the pain treatment could be lifesaving, but that it could also create the feeling of a near-death experience. Further, some patients experienced memory loss regarding the time before surgery, which made it difficult to remember the pain and pain treatment they received. Finally, in paper IV, the staff described that the FNB setting the agenda when caring for older patients with hip fracture in the preoperative phase. Nursing care required timing, with a need of staff orienting to time and customizing their communication. The outcome of the FNB affected nursing care, depending on if the FNB was successful or not successful. Further, staff faced ethical challenges regarding doing good and not harm and relieving pain and avoiding side-effects. Conclusion: This thesis shows that FNB is a feasible preoperative pain management for patients with a hip fracture, even among those with dementia. Evidence-based guidelines are necessary as a basis for assessing pain and providing pain management, but staff should add an individualized pain management approach. Staff should evaluate every patient and see each patient as a unique individual with different experiences of pain and pain management to successfully relieve pain among patients with a hip fracture.
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